Paediatric Ophthalmology

Paediatric Ophthalmology

Assessment

·        Vision: fixation (test independently and together), pictures, symbol matching, E

·        Alignment: inspection, alternating cover test

·        Squint inspection:

o  Corneal reflection when looking at bright light source. Should be in the centre of the pupil on both sides. Cover good eye and see if corneal reflection shifts over the pupil of the bad eye

o  Check for equal schlera on either side of iris.  Wide bridge of nose may give pseudo squint 

o  Can have squint without amblyopia as long as brain alternates which eye it looks through. If preference for one eye, then amblyopia

Amblyopia

·        = “Lazy eye”

·        Affects 2 to 3 per 100 children. Can only occur in childhood while visual pathway still developing 

·        Usually unilateral: maybe bilateral if bad astigmatism or hypermetropia. If unilateral no effect on reading/writing. Treat as insurance against problems in good eye

·        Affects central vision: peripheral vision OK

·        Three major causes:

o  Squint: Most common cause: misaligned or crossed eyes. The crossed eye is „turned off‟ to avoid double vision

o  Unequal focus (refractive error).  One eye is more near/far sighted or astigmatic

o  Visual obstruction: eg Cataract

o  Also caused by ocular motor defects

·        Treatment: force the use of the weak eye by covering the good one (for weeks or months), plus correcting refractive errors with glasses

Refractive errors

·        Myopia

·        Hypermetropia: if equal and severe then squint due to accommodation

·        Stigmatism

·        Anisometropia: difference between two eyes (especially if one normal and other long sighted) – accommodation just makes normal eye go out of focus

Other

·        Congenital cataract

o   Can be autosomal dominant

o   Check for red reflex within 6 weeks

o   May be uni or bilateral, part of a syndrome or isolated

·        Congenital epiphora

o   Watery eye.  Common – lacrimal system not fully developed

o   Spontaneous resolution the norm. Conservative treatment until 12 months. Massage +/-antibiotics (stagnation of tear drainage)

·        Perinatal eye infections

·        Retinoblastoma

·        Retinopathy of prematurity

o   Very premature babies (low risk if over 30 weeks or 1200 g)

o   Spectrum from severe to norm

o   Problem with vascularisation ® retinal detachment over time

·        Congenital Glaucoma: rare.  One cause of red watery eye